Hypertension: adherence to treatment in rural Bangladesh - findings from a population-based study

Khanam, Masuma Akter, Lindeboom, Wietze, Koehlmoose, Tracey Lynn Perez, Alam, Dewan Shamsul, Niessen, Louis ORCID: https://orcid.org/0000-0002-8639-5191 and Milton, Abul Hasnat (2014) 'Hypertension: adherence to treatment in rural Bangladesh - findings from a population-based study'. Global Health Action, Vol 7, e25028.

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Abstract

Background

Poor adherence has been identified as the main cause of failure to control hypertension. Poor adherence to antihypertensive treatment is a significant cardiovascular risk factor, which often remains unrecognized. There are no previous studies that examined adherence with antihypertensive medication or the characteristics of the non-adherent patients in Bangladesh.

Objective
This paper aims to describe hypertension and factors affecting adherence to treatment among hypertensive persons in rural Bangladesh.

Design
The study population included 29,960 men and women aged 25 years and older from three rural demographic surveillance sites of the International Center for Diarrheal Disease Research, Bangladesh (icddr,b): Matlab, Abhoynagar, and Mirsarai. Data was collected by a cross-sectional design on diagnostic provider, initial, and current treatment. Discontinuation of medication at the time of interview was defined as non-adherence to treatment.

Results
The prevalence of hypertension was 13.67%. Qualified providers diagnosed only 53.5% of the hypertension (MBBS doctors 46.1 and specialized doctors 7.4%). Among the unqualified providers, village doctors diagnosed 40.7%, and others (nurse, health worker, paramedic, homeopath, spiritual healer, and pharmacy man) each diagnosed less than 5%. Of those who started treatment upon being diagnosed with hypertension, 26% discontinued the use of medication. Age, sex, education, wealth, and type of provider were independently associated with non-adherence to medication. More men discontinued the treatment than women (odds ratio [OR] 1.74, confidence interval [CI] 1.48–2.04). Non-adherence was greater when hypertension was diagnosed by unqualified providers (OR 1.52, CI 1.31–1.77). Hypertensive patients of older age, least poor quintile, and higher education were less likely to be non-adherent. Patients with cardiovascular comorbidity were also less likely to be non-adherent to antihypertensive medication (OR 0.79, CI 0.64–0.97).

Conclusions
Although village doctors diagnose 40% of hypertension, their treatments are associated with a higher rate of non-adherence to medication. The hypertension care practices of the village doctors should be explored by additional research. More emphasis should be placed on men, young people, and people with low education. Health programs focused on education regarding the importance of taking continuous antihypertensive medication is now of utmost importance.

Item Type:	Article
Subjects:	W General Medicine. Health Professions > Health Services. Patients and Patient Advocacy > W 85 Patients. Attitude and compliance WA Public Health > WA 30 Socioeconomic factors in public health (General) WG Cardiovascular System > WG 100 General works WG Cardiovascular System > WG 20 Research (General)
Faculty: Department:	Clinical Sciences & International Health > Clinical Sciences Department
Digital Object Identifer (DOI):	https://doi.org/10.3402/gha.v7.25028
Depositing User:	Julie Franco
Date Deposited:	18 Dec 2014 11:17
Last Modified:	30 Aug 2019 17:25
URI:	https://archive.lstmed.ac.uk/id/eprint/4620

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